NSG552 Psychopharmacology
Module 1 Discussion
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic.
Group 1. (Class members 1-7) prevailing hypothesis for schizophrenia implicates the neurotransmitter dopamine as playing a key role in the development of the disease. Dopamine acts on several areas of the brain with differing effects. Please outline the key dopamine pathways and the implications of antipsychotic use on each pathway.
Group 2. (Class members 8-14) PA is a 18 yo male college student brought in by police after being found running on the highway. He is extremely paranoid and reports that the mafia is coming for him. When asked, he does admit to auditory hallucinations, mostly a commanding male voice telling him to hurt himself and his family. All pertinent labs and vitals are WNL, urine drug screen is negative. He is admitted to acute inpatient psychiatric unit for his first psychotic episode. He still lives with his parents and his father reports that over the past several months he has secluded himself to his room and can hear him talking “with someone” every once in a while. His father denies any previous medical or psychiatric history for PA and he is not currently taking any medications. He does report the following family history: DM2, dyslipidemia (father, paternal grandfather), schizophrenia (maternal aunt).
What treatment do you recommend for PA's first psychotic episode? Be specific in your answer and support your choice with neurobiologic rationale. Please be very specific in your answer and rationale. Do not go into detail about the disorder at the expense of detail regarding the current treatment of the patient. Choose your treatments as you would if the patient were in front of you. Do not give vague or generalized treatment plans; choose a treatment and explain why you chose it instead of any other options. Include any and all considerations that accompany your choice of treatment plan. For instance, do any diagnostics need to be done prior to initiating a drug?
Group 3. (Class members 15-20) Please discuss the differences between first-generation antipsychotics (FGA) and second-generation antipsychotics (SGA). Include relevant pharmacodynamics and pharmacokinetics and the implications of each. Include the concepts of receptor affinity, binding, and potency.
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 scholarly references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 2 Discussion
Bipolar and Related Disorders and Depressive Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic.
Group 1. WG, a 31-year-old female, has been admitted to your inpatient unit from the ED where she presented unwillingly and accompanied by her husband. She is unable to provide a history right now, but her husband is able to give you the following information: He reports over the past 2 weeks the patient has been uncharacteristically energetic, starting tasks and not finishing them, exhibits hypersexuality, is highly distractible with speech that is "nonsensical". Her speech has also been rapid and pressured. She only sleeps every second or third night and has abdicated all attempts at self care such as hygiene or grooming. The ED diagnosed her with a manic episode. There is no documented history of smoking, alcohol, or illicit substance use. There is no history of any psychiatric illness in the patient or her family. A full work up has been completed and all was normal with the exception of the abnormal findings listed in the table below:
Lab/Vitals
Today
Blood pressure
150/90 (H)
Sodium
120 (L)
What do you recommend for treatment (focus on psychopharmacologic treatment) and monitoring of WG's current symptoms? What, if any, considerations should be made?
Please be very specific in your answer and rationale. Do not go into detail about bipolar disorder at the expense of detail regarding the current treatment of the patient. Choose your treatments as you would if the patient were in front of you. Do not give vague or generalized treatment plans; choose a treatment and explain why you chose it instead of any other options. Include any and all considerations that accompany your choice of treatment plan. For instance, do any diagnostics need to be done prior to initiating a drug?
2. Antidepressant medications can also be classified as monoamine agonists (serotonergic, noradrenergic, and dopaminergic). Identify the classes of antidepressants and outline common side effects and considerations for each.
Group 3. Many psychiatric medications modulate serotonin (5-HT). 5-HT receptors can be grouped into 7 types; 5-HT1-5HT7 with each type having subtypes. Identify the types and subtypes that have the most relevance to depression treatment and discuss the role of each relevant subtype.
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 scholarly references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 3 Discussion
Anxiety Disorders and Obsessive-Compulsive and Related Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 14-20 and beyond are Group 3. This is not a group project. You each post an individual response to the initial topic.
Group 1: Please describe GABA, its role in anxiety and benzodiazepines. What words of caution are prudent when discussing benzodiazepines?
Group 2: Please discuss the role of serotonin in anxiety. Also, why are SSRIs first line treatment in anxiety?
Group 3: Pharmacological treatment strategies for anxiety disorders and OCD seem very similar but there are certain caveats, like differences in evidence or specific FDA indications, for example, that can help to guide your treatment decisions. Discuss the differences in pharmacological treatment you have noted for these four disorders. Citing references like up to date treatment guidelines and primary literature may help your research.
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 4 Discussion
Dissociative Disorders and Trauma- and Stressor-Related Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic.
Group 1. Most PTSD treatment guidelines recommend against the use of benzodiazepines. Provide an evidence-based discussion regarding the use of benzodiazepines in the treatment of PTSD. Consider discussing information like the safety and efficacy reported in the literature, the effect benzodiazepines have on other common treatment modalities for PTSD, etc. Include first line agents for PTSD in the discussion.
Group 2. Discuss fear extinction vs fear conditioning.
Group 3. Describe the various dissociative disorders, their prevalence, etiology, symptoms, and treatments.
Please include neurobiological rationales and explanations in your discussions
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 scholarly references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 5 Discussion
Sleep/Wake Disorders, Somatic Symptom and Related Disorders and Eating Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic
Eating disorders are notoriously difficult to treat and there are only two of these disorders that have FDA approved psychopharmacologic treatment options.
Group 1: Discuss bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorder (BED) recommended treatments, the rationale for the treatments, include the MOA and evidence for its use.
Group 2: Discuss Restless Leg syndrome and Periodic Limb Syndrome. Include etiology and neurobiologic principles. Discuss treatments with emphasis on pharmacologic treatments. Don't forget to include why and how these medications work to reduce symptoms by including the MOA, evidence for its use, and side effects along with patient education.
Group 3: KL is a 79 yo man requesting assistance for “something to help with sleep”. His past medical history is significant for coronary artery disease and s/p CABG, hyperlipidemia, hypertension, major depressive disorder, and benign prostatic hypertrophy. He is taking the following medications: Aspirin 81 mg daily, Lisinopril 20 mg daily, Metoprolol succinate 100 mg daily, Simvastatin 20 mg daily, fluoxetine 40 mg hs, and doxazosin 4 mg hs. He admits to drinking 2 alcoholic drinks/night and denies smoking. Include in your discussion:
The differences in initial, middle, and terminal insomnia and how would you best choose pharmacologic treatment for each one of these based on the half-lives of each hypnotic?
Identify any secondary causes for insomnia.
What treatment plan do you recommend for KL's insomnia? (Be specific with your recommendations-which hypnotic and why)
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 6 Discussion
Substance use Disorders and Addictive Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic
Group 1: Describe the differences between Naloxone, Naltrexone, and Buprenorphine/Naloxone. Include the properties of each, their classification, mechanism of actions, onset, half-life, and formulations (routes of delivery). Please discuss the implications of differences in the clinical setting (including pre-hospital)
Group 2: WG is a 41-year-old female brought herself into the ER last night asking to "detox from vodka." She tells you she has a long-standing history of alcohol dependence with multiple relapses. She also reports that she has experienced alcohol withdrawal seizures before. Current CIWA-Ar is 17. She denies any past medical history but lab work indicates hepatic insufficiency (LFTs x3 ULN). All other lab work is normal. She denies taking any medications.
How will you manage this patient’s withdrawal syndrome?
Group 3: WG has made it through withdrawal without complications thanks to an appropriate management regimen. She would like to consider pharmacological treatment to maintain abstinence. Her LFTs have normalized now that she has been alcohol-free for the past week. She reports taking disulfiram during previous rehabilitation attempts but was unsuccessful, most likely because of adherence issues. Her medical chart indicates she has great insurance so prescription copayments shouldn't be a problem.
What abstinence medication would be most appropriate for WG?
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 7 Discussion
Neuro developmental and Neuro cognitive Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic
Group 1: Discuss first line treatment options for ADHD. What symptoms do you treat first? Also discuss pharmacological considerations for individuals with co-morbid ADHD and tic disorder.
Group 2: Dementia is a term to describe a constellation of symptoms that includes memory impairment, deficits in language, recognition, motor function, or executive functioning. There are four types of dementia; Alzheimer's, Lewy body, Vascular, and Frontotemporal. Please outline the differences between these types and identify the subtypes of each.
Group 3: Please discuss treatments for dementia with an emphasis on cholinesterase inhibitors, NMDA antagonists, and outline psychopharmacological strategies for treating the behavioral symptoms of dementia.Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 scholarly references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
NSG552 Psychopharmacology
Module 8 Discussion
Sexual Dysfunction and Personality Disorders
Please refer to the class list tab to see which group you belong in. It is simply a numerical standing based alphabetically. Count your standing from the top down. Class members 1-7 are in Group 1, 8-14 are in Group 2, and 15-20+ are Group 3. This is not a group project. You each post an individual response to the initial topic.
Group 1: The list of causes or differential diagnoses of sexual dysfunction is quite extensive, but Gabbard's doesn't go into much detail on this topic. For this week's discussion, research potential causes and differential diagnoses of sexual dysfunction and provide a thorough listing of your findings. This will likely include factors in categories like medical, psychiatric, psychosocial, pharmacotherapy, among other categories. Also discuss psychiatric medications that are implicated in sexual dysfunction, those that can improve sexual dysfunction, as well as non-psychiatric medications that are used to treat sexual dysfunction.
Personality disorders are often seen comorbid with other psychiatric illnesses. Some have a much higher prevalence than others and often complicate the clinical picture. Of all the personality disorders (PD), borderline PD, histrionic PD, antisocial PD, and narcissistic PD are frequently seen and demand the attention of the provider.
Group 2: Discuss the limitations of treatment for borderline and histrionic PD and what can be done from a psychopharmacological perspective.
Group 3: Discuss the limitations of treatment for antisocial and narcissistic PD and what can be done from a psychopharmacological perspective.
Post your initial response by Wednesday at midnight. Respond to at least one student with a different assigned DB question by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 scholarly references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.
